SARS-CoV-2 Pandemic Response, Clinical Characteristics and Outcomes at Bangkok's Largest Emerging Diseases Clinical Centre

Background: The SARS-CoV2 pandemic has affected over 3 million people globally. As of 5 April 2020, 2,169 cases were reported in Thailand, with half occurring in Bangkok. Data on interventions to curb the spreading of Coronavirus Disease 2019 (COVID-19) in resource-limited settings are limited. Objectives: To describe the operational response, clinical spectrum and outcomes of COVID-19 at the Thai Red Cross-Emerging Infectious Diseases Clinical Centre (TRC-EID-CC), Bangkok’s largest EID Centre. Methods: A cohort study on COVID-19 patients was performed. Surge capacity preparations utilised healthcare teams for critical care patients in intensive care units, isolation wards for mild to severe cases and home care teams to discharge mild cases early to home isolation or modified hotels with telehealth monitoring. COVID-19 diagnoses were confirmed by reverse transcriptase polymerase chain reaction of SARS-CoV2 from throat and nasopharyngeal swab samples. Case severity was defined as mild, moderate (pneumonia), severe (pneumonia with hypoxaemia) and critical (mechanical ventilation required). Findings: From 15 January to 5 April 2020, 3,885 individuals were screened. Isolation ward capacity was increased by 500% from initial settings and a modified hotel capacity was added. Of the 158 COVID-19 confirmed cases, 63% were mild, 19% moderate, 12% severe and 6% critical. Factor associated with severe and critical cases were age > 45 years, male gender and lymphocyte count < 1.5 x109/L at presentation. All pneumonia cases with the exception of 3 received COVID-19 targeted treatments, 40 (74%) with favipiravir-based regimens and 14 (26%) with hydroxychloroquine and darunavir/ritonavir or azithromycin. Median length of stay was 5 days (IQR 3-10). As of 5 May 2020, 98% were discharged and 30-day mortality rate was zero. Interpretation: Prompt surge capacity planning, monitoring of progression to pneumonia by multidisciplinary teams allocated to patients by disease severity with rapid initiation of antiviral treatment and high quality respiratory care are important in achieving favourable programme outcomes. Funding Statement: This study was supported by the Ratchadapiseksompoj Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (RA (PO) 001/63). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Approval for this study was granted by the Faculty of Medicine, Chulalongkorn University (IRB 312/63). Written informed consent was waived by the Ethics Commission.